AB0153 EFFECT OF STANDING FRAMES USED IN REAL LIFE ON BONE REMODELING IN NON-WALKING CHILDREN WITH CEREBRAL PALSY
Authors: B. Vincent, V. Goeb, S. Fritot, M. Romuald, J. M. Sobhy-Danial, P. Fardellone, L. Le Monnier
Journal: Annals of the Rheumatic Diseases (2022)

Background Children with severe cerebral palsy are prone to low bone mineral density. Standing frames are recommended as postural management for these children. The beneficial effects in promoting bone health remain unclear. Objectives To determine whether static standing frames enhance bone remodeling in real life in severe cerebral palsy. Methods 24 children with severe cerebral palsy GMFCS IV &amp; V were included in the study and were divided into two groups: 13 were using a passive standing frame and 11 were not. We performed a single center retrospective cross-sectional study comparing the two groups using dual X-ray absorptiometry data and tests on biological samples, including bone remodeling factors. Results Total body (less head) bone mineral content was significantly higher in children who used a standing frame for an average of 30 min/day. This was confirmed in the lumbar spine. Although the total body bone mineral density (less head and proximal femur) densitometric data were not significantly higher, a positive trend favored the use of a standing frame in the children. Bone resorptive factors (CTX) were higher in the non standing-frame group, whereas there was no difference among osteoformation factors. No difference in fracture history was found. Conclusion Used in real life, we showed that static standing practice improved mineralization by reducing osteoresorption in non-ambulant children with cerebral palsy. Further studies are needed to determine how standing practice could impact bone mineralization over time in real life and to explore more bone remodeling factors. References [1]Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral Palsy: Current Opinions on Definition, Epidemiology, Risk Factors, Classification and Treatment Options. Neuropsychiatr Dis Treat 2020; Volume 16: 1505–1518. [2]Mergler S, Evenhuis HM, Boot AM, et al. Epidemiology of low bone mineral density and fractures in children with severe cerebral palsy: a systematic review. Dev Med Child Neurol 2009; 51: 773–778. [3]Pin TW. Effectiveness of Static Weight-Bearing Exercises in Children with Cerebral Palsy: Pediatr Phys Ther 2007; 19: 62–73. [4]Kim SJ, Kim S-N, Yang Y-N, et al. Effect of weight bearing exercise to improve bone mineral density in children with cerebral palsy: a meta-analysis. J Musculoskelet Neuronal Interact 2017; 17:334-340. [5]Damcott M, Blochlinger S, Foulds R. Effects of Passive Versus Dynamic Loading Interventions on Bone Health in Children Who Are Nonambulatory: Pediatr Phys Ther 2013; 25: 248–255. [6]Caulton JM. A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy. Arch Dis Child 2004; 89: 131–135. [7]Chad KE, Bailey DA, McKay HA, et al. TThe effect of a weight-bearing physical activity program on bone mineral content and estimated volumetric density in children with spastic cerebral palsy. The journal of pediatrics 1999;135(1):115-7 [8]Han EY, Choi JH, Kim S-H, et al. The effect of weight bearing on bone mineral density and bone growth in children with cerebral palsy: A randomized controlled preliminary trial. Medicine (Baltimore) 2017; 96: e5896. [9]Gudjonsdottir et al. effect of dynamic VS static prone stander on bone mineral density and behaviour in four children with cerebral palsy. Pediatr Phys Ther Spring 2002;14(1):38-46. [10]Ctr M-P, Bma H, S N, et al. Low bone mineral density in ambulatory persons with cerebral palsy? A systematic review. Disabil Rehabil; 41. Epub ahead of print October 2019. DOI: 10.1080/09638288.2018.1470261. [11]Ho S-T. Review of Fractures and Low Bone Mass in Children with Cerebral Palsy. J Orthop Trauma Rehabil 2012; 16: 45–50. Disclosure of Interests None declared